Relief as women say goodbye to stigma of fistula

Kenya: Every woman who suffers from obstetric fistula knows too well that society does not have kind words for her. Word will travel the whole village that she cannot control her bowels. Good friends will part ways, especially in the hour of need. The husband who brought her to hospital to deliver will flee immediately the nurse says she has obstetric fistula.

The condition is brought on by prolonged labour; the sustained pressure of the baby’s head on the mother’s pelvic bone damages her soft tissues, creating a hole, or fistula, between the vagina and the bladder. The result is constant leaking of urine and faeces.

Regina Kalekye Kilaka, 45, and Sabina Mwikali Kaongo, 60, are sisters who are married in Makueni County. On May 19, they coincidentally found themselves on the waiting benches at Machakos Level Five Hospital after hearing about a free fistula medical clinic to mark the International Day for Obstetric Fistula (May 19). The United Nations Fund for Population and other organisations, had planned to have free fistula repairs in Machakos County.

The country representative, Siddharth Chatterjee, said, “Women who suffer from fistula tend to be more stigmatised than those who suffer from HIV and Aids. Many of these women are stigmatised, divorced and ostracised by their families and communities and live in despair.”

After trying traditional medicine and failing to heal, the sisters had learnt to develop a thick skin against stigma and societal condemnation.

Sabina was married in 1980 and had two children, after which she developed obstetric fistula, in 1983. Since then, she has lived with stigma.

Speaking from her hospital bed, she said, “All the other women began gossiping about me. Even my man stopped coming close to me. Even the friends I went to church with stopped coming to my house because I was smelly. Sometimes, I sit alone at home wondering why this happened to me.’’

She hopes that after the surgery, she will be able to reclaim respect in the community.

Next to Sabina’s bed, her sister Regina, who could not hold back tears as she narrated her predicament, said her friends deserted her and her husband married another woman after she developed obstetric fistula in 1999 following the birth of her two children.

She said, “After six hours of labour and trying to give birth at home, my husband took me to hospital. I was admitted and taken to theatre for a Caesarean section. But I lost the baby and developed this condition due to the prolonged labour. I am hopeful that I will go home dry after so many years of suffering,” she said.

Then there is Regina Mwikali, 50, who has had fistula since 1977. For nearly 40 years, she has been discriminated against.

“I stopped going to church to avoid other women. At one time, the women groups said I should leave because they did not want any embarrassment,’’ she recalls, as her eyes shine with hope that finally, she will be free of her long-carried burden.

According to an obstetric fistula surgeon, Hilary Mabeya, between 3,000 and 7,000 Kenyan women join the “stinking’’ bracket every year. However, only 400 cases undergo correctional surgery at Kenyatta National Hospital (KNH) in Nairobi.

The treatment costs between Sh50,000 and Sh60,000 at KNH while it costs twice or even thrice that amount in a private hospital. The prohibitive cost is what keeps most women suffering in silence. Lack of medical follow-up after surgery could also cause the fistula to reccur.

There are four centres where the procedure can be done: KNH, Moi Teaching and Referral Hospital, Eldoret, Kisii Level Five Hospital and Ortum Hospital in West Pokot County.

Beatrice Ogutu, a nurse at KNH who participated in the fistula clinic at Machakos Level Five Hospital, says thousands of women suffer in silence.

And Dr Norris Onzere, a fistula surgeon, believes the solution to the condition lies in training fistula experts.

“We don’t have adequate surgeons to attend to the swelling numbers. It is expensive to go for this training on your own because the Government does not offer scholarships for it. The number of professionals does not match the needs,” he said.

There are less than 15 fistula surgeons in the country and most of them are based in Nairobi.

Since UNFPA rolled out the campaign against obstetric fistula, 2,000 women have been treated.

But still more needs to be done to end fistula, says Chatterjee.